Trust is a popular topic nowadays, but it also seems to be under unprecedented pressure. The word is all the buzz within marketing and branding and is something that every organization wants to achieve and maintain. It is also centrally critical to the patient-physician relationship. 

For those reasons, and more, Proof Strategies studies trust via our annual CanTrust Index. One of the largest annual studies of trust in Canada, the study is conducted in January and uses a 7-point scale to assess varying levels. The recent three years of pandemic have been a particularly interesting period to study trust in our health care system and those who work within it. 

Canadians love to boast about our health care system, especially compared to the U.S., and overall, we have high levels of trust. The pandemic has put that under pressure.

When asked which institutions Canadians are willing to trust to operate competently and effectively and do the right thing – our health care system got the top score, ahead of the Canadian military, the Supreme Court and the education system. However, that trust does seem to be eroding slightly year over year, dropping from 63 per cent to 58 per cent in the past three years. This shift isn’t cause for alarm bells, but is certainly something to keep watching. 

Trust levels in Canada’s health care system vary across the country, possibly resulting from the disparity of services from province to province. Atlantic Canadians are seven per cent less likely to trust the system (coming in at 45 per cent compared to Ontario, the most trusted province, at 58 per cent). Further, trust levels differ between generations. The least trusting are millennials coming in at 45 per cent and the most trusting are Boomers at 64 per cent. This latter difference appears throughout our research, with younger people almost always being less trusting.

We know that some of the key issues facing our health care system continue to be wait times, lack of family physicians, nursing shortages and equal and timely access to medications. Some governments appear to be tackling these issues. 

For instance, provinces are trying to tackle issues related to physician and nursing shortages, which have a direct impact on patient care. The solutions, however, often seem inconsistent and even reactive. Unfortunately, the uncoordinated and almost competitive atmosphere threatens to impact trust levels even more. 

Though we do need solutions to solve these more complex systemic issues, there is another piece of the patient care puzzle where trust levels are equally as important – those with individual care providers, the medical doctors. Our research shows that medical doctors topped the list of trusted individuals to provide reliable information – ahead of family and friends or educators. However, trust in physicians is also eroding. It peaked in 2021 during the height of the pandemic and has fallen since – dropping from 81 per cent to 73 per cent. The frustration among Canadians caused by the pandemic has had an inevitable impact. 

While 73 per cent is still a strong trust level – it is a critical number as the trust that one has with their physician can directly lead to better health outcomes. If a patient trusts their physician and feels like they can be honest without judgement, they will be more likely to provide information that can help them receive better care.

One way to accomplish this is by working to humanize health care. A simple shift from directive behaviour to empathic engagement can have an immediate impact on trust building. For instance, rather than focusing on a patient’s behaviours by asking whether they have done as they were told, employ an empathetic approach and engage the patient in the discussion to determine whether compliance would be a challenge for them. Asking questions such as whether they are able to travel to appointments, affordability of treatments, or how well they understand their diagnosis, can solidify the patient-physician relationship and powerfully build trust. Academic research has found that empathy is a key driver of trust, along with ability and integrity.

Knowing that time is at a premium, it may feel counter-intuitive to add more time to an appointment by asking these questions, or that they may not even be relevant. But consider that providing a quick set of instructions, however accurate they may be, and sending a patient on their way may provide a false sense of accomplishment. An engaged approach may take more time initially, but the trust it builds may ultimately save you time as you will have armed the patient with the information and motivation needed to make change and better their health outcomes. This type of trust-powered care benefits everyone. 

Canadian health care leaders must take note and ensure all aspects of our health care system is rooted in trust. Once trust is gained, it’s a strong and resilient resource that benefits everyone involved.

Jennifer Zeifman is SVP, National Lead, Health & Wellness, at Proof Strategies with over 25 years of experience specializing in healthcare communications. The annual Proof Strategies CanTrust Index, now in its eighth year, is a leading source of research and understanding of trust in Canada.